M&R

Acronyms

100

OOP

Out of Pocket

200

PMG

Provider Medical Group 

300

PERS

Personal Emergency Response System

400

VBC

Value Base Care

500

IPA

Independent Physician Association

M&R

100

What is the medical deductible?

is the amount members will pay full out of pockect for outpatient and inpatient services.

200

who is eligible to get Medicare 

Someone with disability or by turning 65 years old, they can enroll 3 months before birth month, the birth month or 3 months after the birth month.

300

What is Capitation?

Capitation is a payment in advanced PMPM (Per member per month) to the physian and the way to identifie in maestro is that the calims will dispay as denied and payable med-cap

400

What is the difference between routine transportation from emergency transportation. 

Emergency

• Used for an emergency medical condition to get members to the nearest hospital for emergency care.
• These services require an immediate response and could be sent to you by a 911 operator

Non-Emergency

• Used for non-emergent situations and when other types of transportation could put your health in danger.
• If you have a medical condition that requires you to be transported by ambulance to receive medical services (like kidney dialysis), this could be prescribed by your doctor to get treatment.
• Your provider will help you find a non-emergency ambulance provider if you need it.

500

What is the passport benefit 

The UnitedHealth Passport travel benefit allows eligible members to receive non-emergency covered services at in-network copayment/ coinsurance amounts when traveling outside their home service area. Cost-sharing is based on their home plan, not on where they are temporarily located.  

Cultura general

100

these three cities are located near the caribean sea 

a. Tumacoí, Buenaventura y Nuquí.

b. Santa Marta, Barranquilla y Cartagena.

c. Cali, Medellín y Pasto.

b. Santa Marta, Barranquilla y Cartagena.

200

what is the color that represents hope? 

Green 

300

When Diomedes Diaz was born?

26 May 1957

400

Which year Freddy mercury passed away 

1991

500

which year America was discovered 

1492.

True or false

100

With OTC benefits members can get groceries and pay ultility bills 

False

200

A gatekeeper plan means that the member can go to any specialist without a referral 

False

300

Passport benefits allows you to go to OON providers 

False

400

Dental rider can be cancelled at any time during the year.

true

500

If a claim is capitated meas that the calims will be denied and members will be fully covered.

False

General

100

PDP

Prescription Drug Plan

200

What is the difference between outpatient and Inpatient 

An inpatient is a hospital patient who, in most cases, stays in the hospital overnight and meets a set of clinical criteria. Outpatients are people who receive care or hospital services and return home the same day. However, patients who need to stay at the hospital overnight for observation are often still considered outpatients.

300

what year did the Berlin Wall fall?

En 1989.

400

What are the medical condition to get a C-SNP plan? 

diabetes, chronic heart failure and chronic lung disease

500

Credit on account is when members have a positive balance on their monthly premium and they can use it to pay for future monthly bills or for a reimbursment

True